Question
Dear Michael Boss,

I have read your advice with interest.  I recently underwent an MRI which showed a slightly bulging disc between the L4-L5 with signs of small dorsal annulus damage.  However, on the level L5 to S1, on the left side, exists a reasonably large herniated disc with compression on the dural sac on the ventrical left side surrounding and influencing primarily the left S1 root.  In addition, in the lower part of the herniated disc, along the S1 dorsal left, in the level S1-S2 there is a change in the soft parts which they indicate is most likely leaking disc material, also influencing the left S1 root.  Also they note, a bulging disc and limited root canal congestion where a potential if not yet strongly noted influence on the left L5 root.  

With all of this information, I am a little confused about the best course to take.  I see that you have said before that with a herniated disc chiropractic help may not be the long term solution.  I am a Yoga teacher and I really want to avoid having a surgery.  What would you suggest?

I am scheduled to see an orthopedic surgeon shortly.  However I would like to try a chiropractor first?

Thanks for your time!

Gabe Stein

Answer
Gabe,

Thanks for the question.  My first piece of advice is this.  Over 15 years of treating these types of patients, I know one thing, DO NOT SEE AN ORTHOPEDIC SURGEON FOR THIS PROBLEM!!!!!

The surgeon you need to see is a NEUROSURGEON.  I have referred many patients with the types of MRI findings you have. You do not want to see an orthopedist. You want to see a neurosurgeon.  You are talking about your spinal cord and spinal nerves.  This is the area of expertise of a neurosurgeon.  

The patients I have seen that have undergone surgery with an orthopedist have had complications and longterm problems at a high rate.  With a neurosurgeon, just the opposite.  I am not saying they are perfect, but they are much better at performing these surgeries.

With that said, concerning your situation, these MRI findings are not good. Are you having extremity symptoms such as pain, numbness, tingling, weakness?  If you are, given the extent of your findings, I would expect that surgery would be the long term best approach.  However, you could attempt a course of chiropractic care and maybe acupuncture.  With the leaking disc material, the chances of long term relief and resolution through conservative means is less likely.

Cancel your appointment with the orthopedist on Monday.  Find a good neurosurgeon and make your appointment with him.  If you wish to attempt chiropractic between now and then, that would be your call, but you need neurosurgical consult.

I hope this helps. If you have any other questions, please let me know.

Dr. Boss